Alcohol treatment programs know who they serve, but can only estimate who they do not serve;the inability to accurately measure unmet treatment need, especially among women of reproductive age, is a key barrier to developing interventions to reduce alcohol-related health consequences for women, their children, and society. This proposal describes an innovative collaboration to link two existing independent state data systems to create a new, unique longitudinal, epidemiologic database that combines alcohol/drug treatment data with hospital utilization and health outcomes data, to broadly identify alcohol-related problems and the prevalence of unmet treatment need, and to track alcohol-related health outcomes among Massachusetts women of reproductive age and their children. For the first time, women in need of alcohol treatment services who did not receive them will be individually identifiable, allowing for better estimation and description of unmet need. The new linked data will permit assessment of disparities among women with met and unmet treatment need through multiple sources of data, including using a tested algorithm to identify alcohol diagnoses in hospital data. Moreover, the linked data will allow the examination of subsequent health outcomes among women ages 15-49, and birth outcomes among their children. The two data sources to be linked are: (1) the population- based MA Pregnancy to Early Life Longitudinal (PELL) data system, that includes vital records (births, fetal deaths and deaths);hospital discharge, observational stay, and emergency department visit records;and the MA Birth Defects Registry;and (2) the MA Bureau of Substance Abuse Services (BSAS) treatment data system that contains treatment records for over 25,000 annual admissions of women of reproductive age to BSAS-funded substance abuse treatment facilities. The three broad study aims are: 1. Link PELL data to the MDPH-BSAS Treatment Database and verify linkages. 2. Develop and pilot methods a) among all MA women of reproductive age, identify women with alcohol abuse or dependence (2002-2007), assess unmet need for treatment services, and characterize disparities in treatment use, overall and by type (none, detox only, definitive);b) among MA women who had deliveries (2003-2006), describe the pattern of identification and treatment of alcohol problems in the periods before, during, and after pregnancy, assess unmet need for alcohol treatment by type and timing, and characterize pregnancy outcomes;and c) among MA women with an identified alcohol problem develop preliminary multivariate models with predisposing and enabling factors predicting receipt of treatment overall and by type, and, among women who delivered, risk for prematurity. 3. Develop an R01 proposal to describe the impact of substance abuse and treatment on women's and children's health, based on bivariate and multivariate analyses proposed for this study and a tandem NIH/NIDA study. PUBLIC HEALTH RELEVANCE: This innovative public-private collaboration links two existing independent state data systems (BSAS and PELL) to create a new, unique longitudinal, epidemiologic database that combines alcohol/drug treatment data with hospital utilization and health outcomes data, to broadly identify alcohol-related problems and the prevalence of unmet treatment need, and to track alcohol-related health and birth outcomes among Massachusetts women of reproductive age. For the first time, women in need of alcohol treatment services who did not receive them will be individually identifiable, allowing for accurate estimation and description of unmet need, a critical step to improve State alcohol treatment programs for women of reproductive age.